Regional imaging networks need shared workflows, without losing local control

As imaging demand surges and radiology teams struggle to keep pace, NHS imaging teams need better ways to share resources, balance workloads, and extend specialist expertise across sites.

The financial and operational pressure is undeniable. The Royal College of Radiologists reported that the UK spent £362 million in 2025 on short-term fixes such as outsourcing, paid overtime and locums to manage excess workloads. Over the last five years, that spend totalled £1.4 billion. Reporting delays also persist. In 2025, nearly one million scan results in England took over a month, while CT and MRI demand grew by 8% in 2024 and the radiology workforce only grew by 4.7%.

Regional imaging networks offer a promising model for expanding collaboration. Yet, many NHS trusts remain hesitant to adopt models that seem to require full centralisation, disruptive system replacements, or the loss of local autonomy. This hesitation is understandable as each trust operates with its own clinical workflows, governance standards and operational priorities. To succeed, regional networks must facilitate collaboration without forcing every trust into a one-size-fits-all operating model.

The path forward is to implement a shared workflow infrastructure that makes regional collaboration easier while allowing local teams to keep the control they need.

Shared workflows, not just shared images

Image access alone may not solve the underlying operational challenge. While shared access connects images, true collaboration requires shared operations, enabling study routing, reporting queues, prior imaging, clinical context, urgent case escalation, and governance across sites.

Without this operational layer, a network can be technically connected yet functionally fragmented and therefore difficult to use. Separate PACS, RIS, and reporting environments can limit leaders’ visibility to regional backlogs and available capacity. While one site operates at maximum capacity, radiologists at another who could help may be blocked by disconnected systems – which may make regional coordination difficult.

This fragmentation can also create extra work for radiologists and referring physicians, forcing clinicians and administrative teams into ‘swivel-chair’ interoperability as they operate between systems, re-enter data, and track down historical images. This friction may compound radiologist burnout, carries across the entire care pathway, and may contribute to reporting delays.

The goal of regional imaging networks is not to strip away local workflows that serve genuine clinical needs, but to help bridge system gaps. A shared operational infrastructure can turn basic connectivity into true collaboration, by helping identify demand, optimise regional capacity, prioritise urgent cases, and keep care moving forward.

Specialist access requires connected workflows

A patient’s postcode should not unnecessarily limit access to specialist imaging expertise. Regional imaging networks may help bridge system gaps by streamlining how cases are routed to subspecialists. This is especially important for community providers and smaller sites that may rely on access to subspecialists at larger acute trusts, whether in neuroradiology, cardiac, musculoskeletal, or pediatric imaging. In time-sensitive areas, coordinated access to specialist review can be an important operational consideration. Without a shared workflow, arranging a specialist review can often become a slow, manual, and inconsistent process.

A connected workflow does more than give another clinician access to the image. It helps the study, prior imaging, report history, and clinical context all reach the right expert within a single, familiar workflow. For patients, this can help support more coordinated access to imaging information and specialist review across participating sites.

Balancing scale and local control

Regional imaging networks may help enable NHS trusts to manage surging demand by consolidating reporting capacity and routing studies to available specialists across a region. However, each trust remains accountable for patient care, information and data governance, reporting standards, and operational performance, making local control essential. Forced centralisation or ‘rip-and-replace’ approaches can trigger operational resistance by overlooking unique clinical pathways, staffing models, and patient populations that help shape how individual sites function.

Ultimately, effective networks should make it easier for different organisations to work together consistently and transparently.

Interoperability and governance are the foundation

Regional collaboration relies on vendor-neutral interoperability, which may allow studies, reports, worklists, and clinical context to move between organisations without dismantling existing IT environments. The National Imaging Registry (NIR) is an example of an approach which allows authorised clinical systems to find and retrieve imaging history and reports from existing sources, while local trusts retain full data ownership. This demonstrates that regional connectivity may not always require software centralisation but can be supported through intelligent workflow orchestration across existing systems.

However, technical connection is only the beginning. Imaging networks also require clear governance defining who can access studies, how cases are reported, how findings are escalated, and how quality is monitored. Enterprise imaging infrastructure, like InSight PACS*, may help bridge the gap between connectivity and control – supporting regional image sharing, remote reporting, and workflow coordination within a single interface, while accounting for local workflows or requirements.

Connected, not centralised

The future of NHS regional imaging will not be defined by the ability to share static images, but rather by the ability to orchestrate shared workflows, specialist expertise, and operational visibility.

Regional scale does not require sacrificing local control. By embracing interoperable technology, health networks can support the coordination of clinical capacity, simplify imaging workflows, and respect the operational autonomy each trust requires.

Ultimately, connection without centralisation may support sustainable adoption; bridging system gaps to help clinicians coordinate imaging and specialist reviews across sites.

*InSight PACS is available in the United Kingdom only and is not available for sale or use in the United States or other regions. References to InSight PACS relate solely to its deployment within the UK.

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